Public Gives Congress No Clear Guidance on ACA Reform

by Justin McCarthy

Story Highlights

No majority support for any single approach to reform

44% want to keep ACA but make significant changes

Slight majority of Americans (53%) approve of the ACA

WASHINGTON, D.C. -- Lawmakers return to the Hill this week with no clear directive from the American people on how to handle healthcare reform. The largest segment, 44%, wants significant changes to the existing Affordable Care Act law while keeping it in place. Another 30% favors repealing and replacing the law -- in line with Republican lawmakers' intention -- while 23% of Americans want to keep the law as is.

Public Remains Split on Best Approach to the Affordable Care Act

If you had to choose, would you rather keep the Affordable Care Act in place largely as it is, keep the Affordable Care Act in place but make significant changes to it, or repeal the Affordable Care Act and replace it with a new healthcare plan?

Keep as is

Keep but make changes

Repeal and replace

%

%

%

U.S. adults

23

44

30

Democrats

39

55

4

Independents

23

48

25

Republicans

6

23

70

GALLUP, July 5-9, 2017

These latest data, from a July 5-9 Gallup poll, reflect a similar lack of consensus on the issue as in April when Gallup last asked the question.

In May, the House of Representatives narrowly approved a bill to repeal and replace parts of the ACA, but Senate Republicans have not yet settled on a bill that would pass in their chamber.

Republican lawmakers' efforts to repeal and replace the law are in line with the preferences of GOP supporters in the U.S., 70% of whom favor that approach. Meanwhile, 23% of Republicans prefer to keep the act and make significant changes, and just 6% want the ACA to stay in place largely as it is.

A majority of Democrats (55%) would like to make significant changes to the ACA, while 39% would like to keep the ACA in place largely as it is. Few Democrats (4%) support repealing and replacing the law.

Nearly half of independents, 48%, would like to keep the ACA and make changes to it. The remainder of independents divide nearly equally between favoring a repeal or leaving the law in place as is.

Slim Majority of Americans Support the ACA

As its fate hangs in the balance, the ACA receives approval from a slight majority of Americans, 53%. This represents just the second time since Gallup first asked the question in November 2012 that a majority has favored it. The other majority approval, at 55%, occurred in April 2017. Before this year, between 37% and 48% of Americans approved of the ACA.

Bottom Line

President Donald Trump has promised Americans a "beautiful" healthcare bill, but Americans themselves have varying opinions on what such a bill should look like. No groundswell of support is emerging for any approach, but the greatest share of Americans prefer the idea of keeping the law while making significant changes to it.

This puts Trump and congressional Republicans in a difficult position, as repealing the ACA has been the marquee issue of the party's campaigns since the law's passage in 2010. The Republican party now controls both houses of Congress and the White House, but Americans' renewed approval of the ACA challenges the GOP's ability to finally pull the plug on it.

Though the Republicans' proposed legislation would reduce the federal deficit long term, the Congressional Budget Office projects that it would result in 22 million more people being uninsured by 2026, compared with the number of uninsured under the current law -- making the proposal a nonstarter for many lawmakers.

The ACA is unlikely to remain in its current form one way or the other. Sharply rising healthcare costs in many markets and some major insurers abandoning ACA healthcare exchanges altogether may require lawmakers to take action. If Republicans are unable to repeal and replace the ACA, they may need to seek bipartisan support to make changes to it.

Survey Methods

Results for this Gallup poll are based on telephone interviews conducted July 5-9, 2017, with a random sample of 1,021 adults, aged 18 and older, living in all 50 U.S. states and the District of Columbia. For results based on the total sample of national adults, the margin of sampling error is ±4 percentage points at the 95% confidence level. All reported margins of sampling error include computed design effects for weighting.

Each sample of national adults includes a minimum quota of 70% cellphone respondents and 30% landline respondents, with additional minimum quotas by time zone within region. Landline and cellular telephone numbers are selected using random-digit-dial methods.

Americans' reactions to the specific idea of a single-payer healthcare system tilt more positive than negative across a number of different ways of asking about it, but underlying support for the concept of a government-run healthcare system is still in the minority.